外侧单切口四间室减压术治疗小腿筋膜间室综合征  

Treatment of acute leg compartment syndromes by lateral single-incision four-compartment fasciotomy

作　　者：陈华[1] 郝明[1] 张巍[1] 高远[1] 梁向党[1] 张群[1] 郭义柱[1] 陶笙[1] 张立海[1] 唐佩福[1] 

机构地区：[1]解放军总医院骨科,北京100853

出　　处：《中国骨与关节杂志》2015年第6期439-442,共4页Chinese Journal of Bone and Joint

摘　　要：目的：评价外侧单切口四间室筋膜间室减压术（ single-incision four-compartment fasciotomy， SICF ）治疗急性小腿筋膜间室综合征（ compartment syndrome，CS ）的临床效果。方法2011年1月至2013年12月，我院收治32例（32侧）胫腓骨骨折合并小腿 CS 患者。男20例，女12例；年龄25～50岁，平均33.4岁；左侧14例，右侧18例；闭合损伤20例，开放损伤12例（ Gustilo-Anderson I 型8例，II 型4例）。受伤至手术切开减压时间5～16 h，中位时间10 h。术中采用外侧单切口进行小腿四间室减压。结果手术时间40～90 min，平均70.0 min；切口长20～25 cm，平均22.4 cm。术后切口均愈合，无切口感染、下肢深静脉血栓形成、腓浅神经损伤等并发症。32例随访12～24个月随访，平均16个月，骨折均愈合，无骨感染发生。结论 SICF 手术技术软组织损伤相对较小、外科显露清楚、小腿筋膜四间室充分减压，是双切口减压术一种很好的替代方法。Objective To evaluate clinical effects of single-incision four-compartment fasciotomy （ SICF ） in the treatment of acute leg compartment syndromes.Methods From January 2011 to December 2013, 32 patients （ 32 sides ） with acute leg compartment syndromes and tibia and ifbula diaphyseal fractures were treated with SICF techniques. This series covered 20 males and 12 females with the average age of 33.4 years （ range： 25-50 years ）. The left leg was involved in 14 cases, while the right in 18. Twenty patients presented with close injuries, and the other 12 sustained from open fractures （ Gustilo-Anderson I in 8 cases and II in 4 ）. The time from injury to operation ranged from 5hrs to 16 hrs （ neutral： 10 hrs ）. Decompression was done in all cases by SICF technique.Results The operation time ranged 40-90 mins （ mean： 70 mins ）. The length of incision ranged 20-25 cm with a mean of 22.4 cm. The wounds in all cases healed well without any incision related complications such as deep vein thrombosis, peroneal superficial nerve injuries. All patients in this series got followed-up, which ranged from 12 to 24 months with an average of 16 months and revealed fracture union without infections in all cases.Conclusions SICF can provide a complete decompression of the four compartments in the leg with relatively minimal damage to the soft tissues and a clear surgical exploration, being a good alternative to the conventional double incision fasciotomy.

关 键 词：软组织损伤 减压术 外科 筋膜间室综合征 四肢 创伤和损伤 

分 类 号：R687.3[医药卫生—骨科学]